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. <br /> SIGN PERMIT APPLICATION— Burnett County, WI a <br /> N <br /> Permit Fees: a N <br /> 0. , <br /> Off-Premise $100 a <br /> On-Premise $50 �o{ <br /> m <br /> Directional(Off-Premise) $25 <br /> - <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is up to three times the normal fee. 5 i <br /> q <br /> t <br /> Applicant Complete All Sections Below This Line <br /> o • <br /> Property Owner's Name:Capital Growth Buchalter/Michael Kelly r <br /> 0 <br /> 361 Summit Blvd, Suite 110 Burmingham AL 35243 <br /> Property Owners Mailing Address: 9 <br /> City State Zip c' <br /> Contact's Telephone Number:715-687-3250 F= <br /> Contact's Email:shelly@strafordsign.com C <br /> i <br /> Legal Description of Property: Retail Store-Dollar General DJ <br /> Section#: 16 Town#: 40 N Range#: 14 W Town of: Scott <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> Parcel#(24 digits): <br /> 07-028-2-40-14-16-3 04-000-015000 <br /> ND <br /> Tax ID#(1-5 digits): <br /> 18089 <br /> Property Site Address:2432 County Road A, Webster, WI 54893 0 hII <br /> TYPE OF PERMIT(S): Check appropriate box/boxes <br /> N <br /> ❑ Off-Premise 11 On-Premise ❑ Directional (Off-Premise) <br /> Sign Contractor:Strafford Sign Company, LLC cTh -: <br /> Anticipated Construction Start Date:Week of 11-21-22 k <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY m. d. <br /> THIS PERMIT IAS,SUBJLCT TO ALL CONDITIONS LISTED BELOW: <br /> y5: t1 +0 be, 1 oFt o vC Co Rd A r /b hd- o- We / w z <br /> loj at&51" en eC G,/I 5644:Ara-is v Ld Ofd.ilk I1CQ ,L4l1I/,efrtOcI: fs- <br /> z Fee Rec: L) <br /> Ck#: in 963 <br /> e <br /> m <br /> r <br /> z <br /> 9 ocA <br /> ' <br /> Date of staff site visit: 1?"� Initials of si visit aff: m <br /> x �2) <br /> PERMIT APPROVED BY LAND SERVICES OFFICIAL: DATE: <br /> I ID/ zEr l n w CI) - <br /> H in <br /> 3 —CI <br /> o p p <br /> v o co o <br /> Pagelof3 m w .. o <br /> Burnett County,WI Sign Application—Rev 12/2021 $: ^' <br /> m m <br /> H <br /> m ` <br /> L` J <br />